THE STATE OF THE CARDIOVASCULAR SYSTEM IN PATIENTS WITH HYPOTHYROIDISM

Abstract

Objective: to identify the features of risk factors for the progression of damage to the cardiovascular system in patients with primary hypothyroidism

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materials and methods: examination of 57 women with primary hypothyroidism, aged 48 to 60 years. The results were compared with a control group of healthy individuals aged 35 to 45 years (n=15). The 1st group of patients with hypothyroidism included 23 patients in the phase decompensation, group 2 included 34 patients in the compensation phase receiving levothyroxine replacement therapy. A study of the hormonal profile, lipid spectrum, echocardiography with the calculation of the mass of the left ventricle was carried out. Endothelial function was assessed by ultrasound Dopplerography of the brachial artery with a test with reactive hyperemia and a test with hyperventilation.

Results: the groups of patients with decompensation and compensation of hypothyroidism did not significantly differ in age, the duration of the disease, the cause of primary hypothyroidism, the frequency of arterial hypertension and coronary heart disease. The level of total cholesterol in patients with decompensation of the disease did not significantly differ from the compensation group (p=0.57), and in both groups the level of total cholesterol was higher than in healthy individuals (p=0.002 in group 1 and p=0.0007 in group 2). When assessing the parameters of endothelium-dependent vasodilation, in patients with both decompensation of the disease (group I, p=0.043) and compensation (group 2, p=0.02) during the test with reactive hyperemia, a decrease in the increase in the diameter of the artery after cuff application was found, significantly different from the indicators of healthy individuals. In patients with decompensated hypothyroidism in the hyperventilation test, the increase in the diameter of the brachial artery was insufficient, compared with healthy individuals and the indicator in patients with compensated hypothyroidism. The value of the intima media complex in both groups of patients was significantly higher than that in the group of healthy individuals (p=0.003 for group 1 and p=0.0008 for group 2, respectively), the differences between the groups are unreliable (p=0.30). Patients

in both groups had diastolic dysfunction of the type of delayed relaxation (in group 1 in 87.5%, and in group 2 in 93.3%, p=0.4). Both concentric and eccentric types of left ventricular hypertrophy were common among patients of both groups. In both groups 1 and 2, left ventricular hypertrophy was absent only in 34.3% and 31.12%, respectively.

Conclusions: in patients with hypothyroidism, both in the compensation and decompensation phase, hypercholesterolemia, signs of endothelial dysfunction, moderate changes in the wall of the left ventricle in the form of eccentric and concentric hypertrophy, impaired diastolic function, arterial hypertension and ischemic heart disease are detected. If there is a change in patients, even with compensated hypothyroidism, it is necessary to carry out therapeutic measures aimed not only at compensating for the disease, but also at normalizing the lipid spectrum, blood pressure and endothelial function.